Impact of perfusion lesion in corticospinal tract on response to reperfusion
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We aimed to examine the impact of corticospinal tract (CST) involvement in acute ischaemic stroke (AIS) patients on functional outcome and the interaction with reperfusion.
We retrospectively examined data in consecutive anterior circulation AIS patients undergoing thrombolysis. MR perfusion (time to maximum of tissue residue function, Tmax) and apparent diffusion coefficient (ADC) images were transformed into standard space and the volumes of CST involvement by Tmax > 6 s (CST-Tmax) and ADC < 620 × 10−6 mm2/s (CST-ADC) lesions were calculated. Good outcome was defined as modified Rankin scale ≤ 2 at 3 months. Reperfusion was defined as a reduction in Tmax > 6 s lesion volume of ≥70% between baseline and 24 h.
82 patients were included. Binary logistic regression revealed that both CST-Tmax and CST-ADC volume at baseline were significantly associated with poor outcome (p < 0.05). The 24-h CST-ADC volume was correlated with baseline CST-ADC volume in patients with reperfusion (r = 0.79, p < 0.001) and baseline CST-Tmax volume in patients without reperfusion (r = 0.67, p < 0.001). In patients with CST-Tmax volume > 0 mL and CST-ADC volume < 3 mL, the rate of good outcome was higher in patients with reperfusion than those without (70.4% vs 38.1%, p = 0.04).
The use of CST-Tmax in combination with CST-ADC provides prognostic information in patients considered for reperfusion therapies.
• Examine the impact of corticospinal tract involvement in acute ischaemic stroke patients.
• Spatially registered Tmax images can identify corticospinal tract hypoperfusion injury.
• Corticospinal tract salvage through reperfusion is associated with improved outcome.
KeywordsStroke Thrombolytic therapy Magnetic resonance imaging Prognosis Corticospinal tract
Apparent diffusion coefficient
Arterial input function
Acute ischaemic stroke
Corticospinal tract reperfusion rate
Volumes of corticospinal tract involvement by apparent diffusion coefficient < 620 × 10−6 mm2/s
Volumes of corticospinal tract involvement by time to maximum of tissue residue function > 6 s
Diffusion tensor imaging
Montreal Neurology Institute
Motor subscore of the National Institute of Health Stroke Scale
Modified Rankin scale
Magnetic resonance perfusion
National Institute of Health Stroke Scale
Receiver operating characteristic
Recombinant tissue-type plasminogen activator
Singular value deconvolution
Symptomatic haemorrhage transformation
Time to maximum of tissue residue function
We are grateful for the support from our patients.
Compliance with ethical standards
The scientific guarantor of this publication is Min Lou.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: Dr. Liebeskind is among the consultant/advisory board (modest) of Stryker and Covidien. Other authors have no actual or potential conflicts of interest to disclose.
This study has received funding by the National Natural Science Foundation of China (81622017 & 81471170) and the National Key Research and Development Program of China (2016YFC1301500).
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained.
• performed at one institution
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